| NPI | 1629141866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA G57885) |
| Additional Taxonomies | 207ND0101X Dermatology MOHS-Micrographic Surgery (Licence: CA G57885) |
| 207ND0900X Dermatology Dermatopathology (Licence: CA G57885) | |
| 207NP0225X Dermatology Pediatric Dermatology (Licence: CA G57885) | |
| 207NS0135X Dermatology Procedural Dermatology (Licence: CA G57885) | |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2007-07-09 |